The MARCH Mnemonic - A Framework for Tactical Trauma Care

From the MARCH Mnemonic Series – Tactical Trauma Care for EMS Providers

When seconds count and conditions are unpredictable, the MARCH mnemonic. provides a clear, evidence-based sequence for trauma management in both tactical and civilian emergency settings.

Standing for Massive Hemorrhage, Airway, Respiration, Circulation, and Hypothermia/Head Injury, this structured approach originated in Tactical Combat Casualty Care (TCCC) and has become a cornerstone of modern prehospital and field medicine. 

From the battlefield to the back roads, MARCH helps rescuers- military medics, EMS providers, law enforcement officers, and trained civilians - prioritize interventions in the order most likely to save lives. 

By following this systematic progression, responders can rapidly identify and treat life-threatening conditions while preventing secondary injury and deterioration during evacuation. 

Each installment in this upcoming series explores one element of MARCH, offering concise guidance, field considerations and key takeaways tailored for EMS and tactical responders: 

• Part One: Massive Hemorrhage - Stop the bleed, save the life
• Part Two: Airway - Secure it early, maintain it always
• Part Three: Respiration - Restore the breath, relieve the pressure
• Part Four: Circulation - Preserve perfusion, prevent shock
• Part Five: Hypothermia & Head Injury - Protect the head, protect the brain
  

Whether in an urban response zone, rural rescue, or austere tactical environment, MARCH isn’t just a checklist - it’s a mindset. It empowers providers to think clearly, act decisively, and deliver lifesaving care under pressure.

Further Reading:

American College of Surgeons Committee on Trauma. (2022) Advanced Trauma Life Support (10th Ed). Chicago, IL: American College of Surgeons.

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, MA: Pearson Education

Butler, F. K. (2017) Tactical Combat Casualty Care: Beginnings. Wilderness & Environmental Medicine 28 (2S): S12-S17. 

Retrieved from https://pubmed.ncbi.nlm.nih.gov/28284483/ on October 8, 2025

Butler, F. K., Bennett, B., & Wedmore, C. I. (2017) Tactical Combat Casualty Care and Wilderness Medicine: Advancing Trauma Care in Austere Environments. Emergency Medicine Clinics of North America 35 (2): 391-407. Retrieved from https://pubmed.ncbi.nlm.nih.gov/28411934/ on October 8, 2025

Committee on Tactical Combat Casualty Care (2023) Tactical Combat Casualty Care (TCCC) Guidelines for Medical Personnel. Defense Health Agency, Joint Trauma System. Retrieved from https://jts.health.mil on October 8. 2025

National Association of Emergency Medical Technicians NAEMT (2020) TECC: Tactical Emergency Casualty Care Course Book (2nd Ed). Burlington, MA: Jones & Bartlett Learning

National Association of Emergency Medical Technicians NAEMT (2023) Tactical Emergency Casualty Care (TECC) Guidelines. NAEMT Education Division

National Association of Emergency Medical Technicians NAEMT (2025) 

PHTLS: Prehospital Trauma Life Support, Military Edition eBook (10th Ed). Burlington, MA: Jones & Bartlett Learning

EMS Mnemonics - SALAD

For EMS providers, understanding the SALAD mnemonic in the context of airway management is crucial for effectively dealing with contaminated airways, particularly in emergency situations.

The SALAD (Suction-Assisted Laryngoscopy and Airway Decontamination) technique was developed by Dr. James DuCanto. Dr. DuCanto is an anesthesiologist and the Director of the Simulation Center at Aurora St. Luke's Medical Center in Milwaukee, Wisconsin. He is known for his contributions to airway management and the development of innovative techniques, including SALAD.

The SALAD technique is designed to address challenges in managing the airways of patients who are actively vomiting or have a risk of airway contamination. It involves the proactive use of suction to clear the upper airway before and during laryngoscopy, with the goal of optimizing visualization and reducing the risk of aspiration during emergency airway management. The technique often involves the use of the Ducanto catheter, a rigid suction catheter specifically designed for emergency airway situations.

Here's what EMS providers need to know about SALAD:

SALAD Mnemonic:

S - Suction-Assisted: The SALAD technique involves suction-assisted airway management. It emphasizes the proactive use of suction to clear the upper airway of contaminants such as blood, vomit, or other secretions.

A - Laryngoscopy & Airway Decontamination: SALAD stands for Suction-Assisted Laryngoscopy and Airway Decontamination. The primary goal is to optimize visualization during laryngoscopy while simultaneously decontaminating the airway.

L - Laryngoscope Blade-Like Use of Suction Catheter: The rigid suction catheter is used in a manner similar to a laryngoscope blade. It is employed to compress the tongue, distract the lower mandible, and lift the base of the tongue off the posterior pharyngeal wall. This technique aids in the insertion of oral airways, supraglottic airways (SGAs), and laryngoscopes.

A - Aspiration Prevention: One of the main objectives of SALAD is to prevent massive aspiration during emergency airway management. Proactive suctioning is employed before basic and advanced life support maneuvers to reduce the potential for forcing aspiration of airway contaminants.

D - Ducanto Catheter Utilization: The SALAD technique often involves the use of the Ducanto catheter, a rigid suction catheter designed for emergency airway management. The catheter assists in clearing the upper airway and plays a role in creating space during the insertion of oral airways, SGAs, and laryngoscopes.

Key Points for EMS Providers:

Clinical Context: SALAD is particularly relevant in situations involving copious secretions, blood, or emesis, such as out-of-hospital cardiac arrest (OHCA) scenarios.

Operator Proficiency: EMS providers must be technically proficient in the SALAD technique to ensure effective airway management without compromising the view of the airway.

Proactive Suctioning: The proactive use of suction as the initial step in emergency airway management is emphasized. This helps prevent aspiration during face mask ventilation and ventilation through SGAs.

Wider Application: While initially focused on managing contaminated airways, the SALAD technique's proactive use of a rigid suction catheter suggests potential applications in various emergency airway management scenarios.

Training: EMS providers should receive proper training and education on the SALAD technique, including the correct utilization of the Ducanto catheter and the proactive use of suction during airway interventions.

Understanding and implementing the SALAD mnemonic can enhance the capabilities of EMS providers in managing challenging airway situations, ultimately contributing to better patient outcomes during emergencies.

Further Reading:

Root, C. Et Al.(2020) Suction Assisted Laryngoscopy and Airway Decontamination (SALAD): A Technique For Improved Emergency Airway Management. Resuscitation Plus. Science Direct.

https://www.sciencedirect.com/.../pii/S2666520420300059 Accessed January 10, 2024

EMS Mnemonics - LEMONS

The LEMONS mnemonic is a helpful tool for EMS providers to assess the viability of airway intubation.

Here's what you need to know about it:

- L: Look Externally: Assess the patient's anatomy, facial trauma, and potential airway obstructions.

- E: Evaluate the 3-3-2 Rule: Ensure that the patient has at least three fingers' width of space between the incisors, three fingers' width from the angle of the jaw to the hyoid bone, and two fingers' width from the thyroid cartilage to the floor of the mouth.

- M: Mallampati Score: Determine the Mallampati score, which classifies the visibility of the oropharyngeal structures. This helps predict the ease of intubation.

- O: Obstruction / Obesity: Identify any airway obstructions or obesity-related challenges that may affect the intubation process.

- N: Neck Mobility: Assess the patient's ability to extend their neck and achieve optimal alignment for intubation.

- S: Stiffness: Evaluate the stiffness or rigidity of the patient's chest wall, as this may complicate bag-mask ventilation and intubation.

By considering these factors, EMS providers can better prepare for airway intubation and make informed decisions to ensure patient safety and successful intubation.

EMS Mnemonics - MARCH

EMS providers should be familiar with the MARCH mnemonic, which is a systematic approach to trauma patient assessment. 

Each letter in MARCH stands for a critical aspect of assessment and treatment:

1. M - Massive Hemorrhage: Assess for life-threatening bleeding and apply direct pressure or tourniquets as necessary. 

For example, if a patient has a severe laceration with uncontrolled bleeding, immediate pressure or a tourniquet should be applied.

2. A - Airway: Ensure the patient's airway is clear and assess for any obstructions or injuries that may compromise breathing. 

For instance, if a patient is unconscious and has a suspected neck injury, manual inline stabilization should be applied while maintaining an open airway.

3. R - Respiration: Evaluate the patient's breathing and address any issues that may impair ventilation. 

For example, if a trauma patient is experiencing shallow or labored breathing, supplemental oxygen or advanced airway management may be required.

4. C - Circulation: Assess the patient's circulation and address any signs of shock or inadequate perfusion. 

If a trauma patient presents with a weak pulse, rapid heart rate, and low blood pressure, intravenous fluids or blood products may be administered to restore circulation.

5. H - Hypothermia/Hyperthermia: Monitor the patient's body temperature and implement measures to prevent or treat hypothermia or hyperthermia. 

For instance, if a trauma patient is found in a cold environment, active rewarming techniques should be initiated to prevent further heat loss.

It's important to note that there are variants of the MARCH mnemonic, such as L-MARCH, which includes the addition of "L" for Laboratory and "Lethal Triad" (coagulopathy, acidosis, and hypothermia). 

These variants emphasize the importance of laboratory testing and addressing the lethal triad in trauma patients.

Remember, the MARCH approach provides a systematic framework for trauma assessment, but its application should be tailored to the specific needs of each patient. 

EMS Mnemonic - CUPS

EMS providers should be familiar with the CUPS mnemonic when it comes to pediatric patient assessment, as it provides a systematic approach to categorizing and prioritizing patients based on their clinical status.

Here's a summary of what EMS providers need to know about CUPS:

C - Critical:

Definition: Patients in this category have absent airway, breathing, or circulation.

Action: Requires immediate and rapid interventions, as well as urgent transport.

Reassessment: Must be reassessed frequently to monitor and respond to changes in the patient's condition.

U - Unstable:

Definition: Patients with compromised airway, breathing, or circulation along with altered mental status.

Action: Requires rapid interventions and transport.

Reassessment: Similar to critical patients, unstable patients need frequent reassessment to ensure ongoing stability.

P - Potentially Unstable:

Definition: Patients with normal ABCs but present with significant illness or injury.

Action: Requires initial assessments with prompt interventions.

Assessment: A focused physical assessment and history are important during transport.

S - Stable:

Definition: Patients with normal ABCs and without significant illness or injury.

Action: Requires a focused physical assessment and history during routine transport.

EMS providers should use the CUPS mnemonic as a guide to determining the urgency of treatment and transport for pediatric patients.

It helps prioritize interventions based on the severity of the patient's condition.

Regular reassessment is emphasized for critical and unstable patients to adapt to changing conditions and provide appropriate care throughout the transport process.

Familiarity with such mnemonics is essential for effective and efficient pediatric patient management in emergency situations.

EMS Mnemonics - TICLS

The TICLS mnemonic is a useful tool for EMS providers during pediatric patient assessments.

Here's what you should know:

T - Tone: Assess the child's muscle tone. Are they floppy or rigid?

I - Interactiveness: Observe their level of interaction. Are they responsive or unresponsive?

C - Consolability: Determine if the child can be consoled or comforted.

L - Look or Gaze: Assess their eye contact and gaze. Are they making appropriate eye contact?

S - Speech or Cry: Evaluate the quality of speech or cry. Is it appropriate for their age?

Using the TICLS approach helps providers quickly assess the child's neurological status and identify any abnormalities or concerns.

It's important to remember that this is just one component of a comprehensive pediatric assessment, and additional assessments and interventions may be necessary based on the specific situation.

EMS Mnemonics - BE FAST

EMS providers should be familiar with the BE FAST mnemonic as it relates to stroke recognition and assessment. BE FAST helps us identify common stroke symptoms and prompt appropriate action.

Here's what EMS providers need to know:

B - Balance: Check if the person has a sudden loss of balance or coordination. Watch for stumbling, difficulty walking, or a sudden onset of dizziness.

E - Eyes: Look for sudden vision changes, such as blurred or double vision, or vision loss in one or both eyes. Ask the person if they are experiencing any visual disturbances.

F - Face: Ask the person to smile and check for facial drooping or asymmetry. A lopsided smile or drooping on one side of the face is a potential sign of a stroke.

A - Arms: Have the person raise both arms and observe if one arm drifts downward or cannot be held up. Weakness or numbness in one arm or hand is indicative of a stroke.

S - Speech: Listen for slurred or garbled speech. Ask the person to repeat a simple phrase and watch for difficulty speaking or understanding. Incoherent or abnormal speech may suggest a stroke.

T - Time: Time is critical in stroke cases. If any of the above symptoms are present, please note when they started. The sooner the person receives medical attention, the better their chances of receiving appropriate treatment.

By using the BE FAST mnemonic, EMS providers can quickly assess stroke symptoms and initiate appropriate care. It's important to remember that this is a screening tool and not a definitive diagnosis. Timely transportation to a stroke center is crucial for further evaluation and treatment.

EMS Mnemonics - RICES

EMS Providers should be familiar with the RICES mnemonic as it relates to the initial care and management of soft tissue injuries. RICES stands for:

Rest: The injured area should be rested to prevent further damage and allow the body to initiate the healing process. Limiting movement and weight-bearing on the injured limb or area is essential to avoid exacerbating the injury.

Ice: Applying ice to the injured area helps reduce swelling and inflammation. Use a cold pack or ice wrapped in a cloth and apply it to the injured site for 15-20 minutes every 1-2 hours during the initial 24-48 hours after the injury. Ensure that you place a barrier (such as a cloth) between the ice and the skin to prevent frostbite.

Compression: Use an elastic bandage or compression wrap to gently compress the injured area. This helps reduce swelling and provides support. Be careful not to wrap it too tightly, which could impede blood flow. You should be able to slide a finger beneath the bandage.

Elevation: Elevating the injured limb or area helps minimize swelling by allowing excess fluid to drain away from the site. For example, if the injury is in the leg, elevate it above heart level when possible.

Stabilization: Immobilize or stabilize the injured area, especially if there is a risk of further injury due to movement. This can be achieved with splints or slings when necessary to prevent further harm.

EMS providers should keep in mind that the RICES protocol is most effective for acute soft tissue injuries, such as sprains, strains, and contusions. It can provide initial relief and help with pain and swelling reduction. 

However, for more serious injuries or fractures, further medical evaluation and interventions may be required. It's also essential to consider any contraindications, such as not applying ice directly to open wounds or areas with impaired circulation.

Additionally, the mnemonic PRICE is a similar concept but includes "Protection" as the first step. In some cases, protecting the injured area from further harm may be necessary before starting RICES, especially in emergency situations.

Overall, EMS providers should be knowledgeable about the appropriate first aid and initial care for soft tissue injuries to help improve patient comfort and outcomes.

#EMS #Mnemonics #SoftTissueInjury #Rest #Ice #Compression #Elevation #Stabilization

EMS Mnemonics - DCAP BTLS

 

EMTs shoul be aware of the mnemomic DCAP-BTLS and how it is used as part of the patient assessment process to identify potential injuries.

Here's what it stands for:

D - Deformities: Look for any visible abnormalities or misalignments of bones or joints.

C - Contusions: Observe for bruises or areas of localized bleeding under the skin.

A - Abrasions: Check for superficial scrapes or scratches on the skin's surface.

P - Punctures/Penetrations: Assess for any wounds caused by objects piercing the skin.

B - Burns: Identify any burns or evidence of thermal injuries.

T - Tenderness: Note areas of pain or tenderness when touched.

L - Lacerations: Look for cuts or tears in the skin.

S - Swelling: Observe for any abnormal swelling or edema.

By systematically evaluating each element of DCAP-BTLS, EMTs can identify potential injuries and prioritize appropriate care for trauma patients. 

Remember, this information is not a substitute for formal medical training.

EMS Mnemonics - TRACEM

TRACEM is a mnemonic used to determine the type of damage possible from a hazardous material exposure: thermal, radiological, asphyxiation, chemical, etiological, mechanical

.It is used in the context of emergency response and hazardous materials management to categorize the different types of damage that can occur to hazardous materials containers or packaging.

Understanding the type of damage is crucial for first responders and hazardous materials teams when assessing the potential risks and determining appropriate mitigation measures. Here's what each letter in TRACEM represents:

T - Thermal Damage: Thermal damage refers to damage caused by heat or fire. It includes situations where the hazardous material container has been exposed to high temperatures, leading to structural damage or rupture.

R - Radiological Damage: Radiological damage involves hazardous materials that emit ionizing radiation. Damage to the container may result from radiation exposure or a breach of radioactive materials.

A - Asphyxiation Damage: Asphyxiation damage pertains to hazardous materials that can displace oxygen or release gases that are harmful or oxygen-depleting. Damage scenarios may involve leaks or ruptures leading to oxygen-deficient atmospheres.

C - Chemical Damage: Chemical damage relates to the release or spill of hazardous chemicals due to container damage. This can result in exposure to harmful or toxic substances.

E - Explosive Damage: Explosive damage involves hazardous materials that are reactive and prone to explosion. Damage to the container may lead to explosive incidents.

M - Mechanical Damage: Mechanical damage includes physical damage to the container or its packaging. This can result from impact, compression, puncture, or other forms of mechanical stress.

Understanding these types of hazardous material damage helps emergency responders assess the situation, determine the appropriate protective actions, and establish safe zones during incidents involving hazardous materials. It also guides decisions on containment, mitigation, and evacuation measures to protect public safety and the environment.